| NPI | 1033573407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-01541) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA T288342) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 271414) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2022-09-02 |